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Choosing the Right Health Plan

Did you get a new employer, and you have become eligible for coverage? Have you already been with an employer and it’s their open enrollment period? Are you qualified for an ACA Marketplace plan, or Medicare coverage, and it’s a special enrollment period or open enrollment period? There are so many scenarios where you have the opportunity to select a health insurance plan? Depending on your situation, you may have an overwhelming amount of options to select from? How do you decide?


First, you want to know where to go to select your options. If it’s through an employer, your HR representative will help you. They may even have an agent on hand to help answer questions. If you have confidence in what you are doing ACA Marketplace and Medicare give you access to view your options. Through healthcare.gov for the Marketplace or Medicare.gov for Medicare options, you can research and enroll yourself. Navigating through health insurance can get tricky and overwhelming; that’s where insurance agents come in. We take the time to learn about you and do the navigating for you.


To help narrow down the options, you should consider your health needs. Depending on where you are accessing your coverage, there is a variety of benefit options to consider. No matter where you are accessing your coverage, you should consider the reason why you are looking for coverage. Are you rather healthy and just need it for preventative reasons? Do you fear catastrophic events could happen and you want help paying for those situations? Is your health not the greatest and you know you visit the doctors and hospitals more often than others? The way you answer these questions will help determine the coverage that you should be looking into.


Networks are another important factor to consider. If there are particular doctors that you see and that you want to continue to see, you want to be sure that they are in network of the plans that you search. If they are not in network, you’ll either need to find another doctor or pay out of pocket. You want to pay attention to if the plan type is a PPO, HMO, or another type. It will determine how restrictive your range of providers are, if you can see a doctor out of your network, and if you require an authorization to see a specialist or get certain tests done.


Do you take prescription medications? If so, this is another important factor to consider. Health plans have what is called a formulary, which is a list of medications that are covered by the plan. Not all medications are covered by all plans. Whether they are covered and what level of coverage they fall on can make a difference to how you view the plan.


Budget is a very important factor. If you can’t afford the monthly premium, you won’t be able to keep the health plan active. That makes everything else irrelevant. In addition to the premium, the out-of-pocket costs, like copays and deductibles, are also important. If you can’t afford these costs, You’re most likely not going to get the health care you need.


Another detail to consider is the star rating of the plan. The ratings are determined by a few different things. Health insurance plans may get compliments or complaints about a plan; this can affect the rating. How well or how quickly a claim is paid can also affect the rating. The healthcare providers also give their input about a plan. Through all the feedback the health insurance receives about their plans, they are able to obtain ratings. This factor may or may not make or break your decision about a plan, but it is something to consider.


Again, this is a lot to consider, which can become quite overwhelming. A good health insurance agent will ask the right questions then do the research for you. Once figuring out which plan is most suitable for your needs and budget, they should explain the plan and why it’s a fit for you.

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